{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,5]],"date-time":"2026-06-05T19:11:35Z","timestamp":1780686695946,"version":"3.54.1"},"reference-count":39,"publisher":"Walter de Gruyter GmbH","issue":"7","license":[{"start":{"date-parts":[[2026,4,20]],"date-time":"2026-04-20T00:00:00Z","timestamp":1776643200000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,6,24]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec id=\"j_cclm-2025-1709_abs_001\">\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To evaluate whether antinuclear antibody (ANA) titre or HEp-2 fluorescence patterns are associated with antiphospholipid antibody (aPL) serological intensity, and to examine component-specific complement abnormalities\u00a0\u2013\u00a0particularly low C4\u00a0\u2013\u00a0as laboratory correlates compatible with classical-pathway involvement.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"j_cclm-2025-1709_abs_002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      This retrospective cross-sectional study analysed 626 consecutive diagnostic samples with same-day testing for lupus anticoagulant (LA), anticardiolipin (aCL), anti-\u03b2\n                      <jats:sub>2<\/jats:sub>\n                      -glycoprotein I (anti-\u03b2\n                      <jats:sub>2<\/jats:sub>\n                      GPI) antibodies, and ANA. aPL serological intensity was categorised from 0 to 3 (negative to triple-positive) using predefined laboratory cut-offs. ANA patterns were grouped as negative, homogeneous, speckled, or other. Complement variables included low C3, low C4, and combined hypocomplementaemia. Associations were assessed using ordered logistic regression, with Firth bias-reduced logistic regression applied for binary outcomes with sparse events.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"j_cclm-2025-1709_abs_003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Overall, 26.5\u202f% of samples (166\/626) were aPL-positive, including 1.6\u202f% triple-positive cases (10\/626). High-titre ANA (\u22651:160) was not associated with higher aPL serological intensity (OR 1.00, 95\u202f% CI 0.51\u20131.96). In contrast, homogeneous (OR 1.99, 95\u202f% CI 1.26\u20133.18) and speckled (OR 2.85, 95\u202f% CI 1.66\u20134.91) ANA patterns were independently associated with higher aPL categories. Low C4,\u00a0\u2013\u00a0but not low C3\u00a0\u2013\u00a0was associated with aPL positivity in binary analysis (Firth OR 6.84, p=0.001; low-C4 events n=10).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"j_cclm-2025-1709_abs_004\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>ANA fluorescence patterns, but not ANA titre, are associated with higher aPL serological intensity, indicating a distinct laboratory serological phenotype. Low C4 shows an association compatible with classical-pathway complement involvement. These findings are observational and require validation in longitudinal studies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1515\/cclm-2025-1709","type":"journal-article","created":{"date-parts":[[2026,4,25]],"date-time":"2026-04-25T10:03:57Z","timestamp":1777111437000},"page":"1647-1655","source":"Crossref","is-referenced-by-count":0,"title":["ANA fluorescence patterns and low C4 are associated with higher antiphospholipid antibody serological intensity in routine diagnostic testing"],"prefix":"10.1515","volume":"64","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8842-2360","authenticated-orcid":false,"given":"Nikolaos","family":"Androulakis","sequence":"first","affiliation":[{"name":"Hematology Laboratory , University Hospital of Iraklion , Iraklion , Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olga","family":"Striligka","sequence":"additional","affiliation":[{"name":"Hematology Laboratory , University Hospital of Iraklion , Iraklion , Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eleni","family":"Nioti","sequence":"additional","affiliation":[{"name":"Hematology Laboratory , University Hospital of Iraklion , Iraklion , Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonios","family":"Dilintas","sequence":"additional","affiliation":[{"name":"Hematology Laboratory , University Hospital of Iraklion , Iraklion , Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aikaterini","family":"Darivianaki","sequence":"additional","affiliation":[{"name":"Laboratory of Experimental Endocrinology\/Clinical Immunology , University Hospital of Iraklion , Iraklion , Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anastasia","family":"Papadopoulou","sequence":"additional","affiliation":[{"name":"Hematology Laboratory , University Hospital of Iraklion , Iraklion , Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fotini","family":"Nistikaki","sequence":"additional","affiliation":[{"name":"Hematology Laboratory , University Hospital of Iraklion , Iraklion , Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Theodosia","family":"Iatridi","sequence":"additional","affiliation":[{"name":"Hematology Laboratory , University Hospital of Iraklion , Iraklion , Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marilena","family":"Kampa","sequence":"additional","affiliation":[{"name":"Laboratory of Experimental Endocrinology\/Clinical Immunology , University Hospital of Iraklion , Iraklion , Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christina","family":"Kalpadakis","sequence":"additional","affiliation":[{"name":"Hematology Laboratory , University Hospital of Iraklion , Iraklion , Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"374","published-online":{"date-parts":[[2026,4,20]]},"reference":[{"key":"2026060518413059259_j_cclm-2025-1709_ref_001","doi-asserted-by":"crossref","unstructured":"Miyakis, S, Lockshin, MD, Aatsumi, T, Branch, DW, Brey, RL, Cervera, R, et al.. 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